Week 5
What pharmacologic agents are currently recommended for the treatment of GERD?
Antacids
Antacids relieve heartburn (indigestion). They work by changing the stomach acid that causes
heartburn. Common OTC antacids include:
• Mylanta
• Rolaids
• Tums
Histamine-2 (H2) blocfieís
H...
week 5 what pharmacologic agents are currently recommended for the treatment of gerd antacids antacids relieve heartburn indigestion they work by changing the stomach acid tha
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Week 5
What pharmacologic agents are currently recommended for the treatment of GERD?
Antacids
Antacids relieve heartburn (indigestion). They work by changing the stomach acid that causes
heartburn. Common OTC antacids include:
• Mylanta
• Rolaids
• Tums
Histamine-2 (H2) blocfieís
H2 blockers relieve and prevent heartburn and work by reducing the amount of acid produced by
the stomach. Typically, they start to work within one to three hours and provide acid-suppression
for several hours. Because acid reducers may interact with certain other medicines, ask your
doctor or pharmacist before use if you are taking a prescription drug. Common OTC H2-blockers
include:
• Tagamet HB (cimetidine)
• Pepcid Complete or Pepcid AC (famotidine)
• Axid AR (nizatidine)
Píoton pump inhibitoís (PPIs)
OTC PPIs treat frequent heartburn (occurs 2 or more days a week) and are not intended for
immediate relief of heartburn, as they may take one to four days for full effect. In contrast,
prescription PPIs are used to treat conditions like gastroesophageal reflux disease (GERD),
stomach and small intestine ulcers, and inflammation of the esophagus. PPIs work by reducing
the amount of acid produced by the stomach. Because acid reducers may interact with certain
other medicines, ask your doctor or pharmacist before use if you are taking a prescription
drug. OTC PPIs are only intended for a 14-day course of treatment and can be used up to three
times per year.
• Prevacid 24HR (lansoprazole)
• Nexium 24HR (esomeprazole)
• Prilosec OTC (omeprazole magnesium)
• Zegerid OTC (omeprazole and sodium bicarbonate)
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What are the pharmacologic regimens for treatment of H-pylori?
RECOMMENDED
, Claíithíomycin tíiple theíapy consists of a PPI, claíithíomycin (Biaxin), and amoxicillin oí
metíonidazole (Flagyl) foí 14 days. ľhe effect of H. pyloíi íesistance to claíithíomycin is well
documented. Claíithíomycin should be avoided in locations wheíe íesistance is gíeateí than 15%
and in patients with any píevious macíolide exposuíe.
Bismuth quadíuple theíapy consists of a PPI, bismuth, tetíacycline, and a nitíoimidazole foí 10 to
14 days. It may be a paíticulaíly good option in patients with macíolide exposuíe oí who aíe
alleígic to penicillin. Although metíonidazole íesistance impacts the effectiveness of this íegimen,
it is not neaíly as píofound as with claíithíomycin tíiple theíapy. Bismuth quadíuple
theíapy should be stíongly consideíed as fiíst-line tíeatment wheíe claíithíomycin íesistance is high
oí in patients with any píevious macíolide exposuíe.
Concomitant theíapy consists of a PPI, claíithíomycin, amoxicillin, and a nitíoimidazole
(tinidazole [ľindamax] oí metíonidazole) foí 10 to 14 days. ľhis íegimen is a píomising option
that has been shown in inteínational studies to be at least as effective as claíithíomycin tíiple
theíapy with similaí toleíability. Limited data show that the effects of claíithíomycin íesistance
with this íegimen aíe less than with claíithíomycin tíiple theíapy. A duíation of 10 to 14 days
seems appíopíiate, although studies to assess whetheí extending theíapy to 14 days impíoves
eíadication aíe ongoing.
What would the pharmacologic regimen for the treatment of H-pylori be for a patient with a documented allergy to
penicillin?
Bismuth quadíuple theíapy consists of a PPI, bismuth, tetíacycline, and a nitíoimidazole foí 10 to
14 days. It may be a paíticulaíly good option in patients with macíolide exposuíe oí who aíe
alleígic to penicillin. Although metíonidazole íesistance impacts the effectiveness of this íegimen,
it is not neaíly as píofound as with claíithíomycin tíiple theíapy. Bismuth quadíuple theíapy should
be stíongly consideíed as fiíst-line tíeatment wheíe claíithíomycin íesistance is high oí in patients
with any píevious macíolide exposuíe.
What pharmacologic agent is the standard for treatment of ulcerative colitis?
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis and
are appropriate for the majority of people with this condition. These drugs include:
• 5-aminosalicylates. Examples of this type of medication include sulfasalazine (Azulfidine),
mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum).
Which one you take, and whether it is taken by mouth or as an enema or suppository,
depends on the area of your colon that's affected.Corticosteroids. These drugs, which
include prednisone and budesonide, are generally reserved for moderate to severe
ulcerative colitis that doesn't respond to other treatments. Due to the side effects, they are
not usually given long term.
What pharmacologic agent is often prescribed for exacerbations of inflammatory bowel disease?
• Corticosteroids. These drugs, which include prednisone (Orasone, deltasone),
methylprednisolone (medrol) and controlled release oral budesonide (entocort EC), are
generally reserved for moderate to severe ulcerative colitis that doesn't respond to other
treatments. Due to the side effects, they are not usually given long term.
o Oral budesonide treatment of choice in mild to mod exacerbations with 5-ASA or as
monotherapy
• Dosage
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